Sugar | Bonnie Modugno, MS, RD

GUT HEALTH: What are we feeding our babies?

November 15, 2012 by Bonnie

Months ago I wrote that understanding human microbiota is a game changer. There is not enough evidence to know the exact mechanisms linking disease and our resident microbes, but what is understood is that our environment plays a major role in the kinds of microbes that populate our gut in the first place, especially diet. Nowhere is that more avidly explored than in the health of infants and children.

COLONIZING A BABY’S GUT

A baby’s gut is rather sterile until it pushes through the birth canal and the baby suckles at it’s mother’s breast. Both a vaginal birth and breastfeeding are primary ways to colonize the infant’s gut with the mother’s healthy bacteria. If the baby is born via c-section and fed formula a very different bacteria flora is supported. Formula manufacturers are very tuned into this research, adding probiotics and prebiotic ingredients that attempt to mimic what happens naturally with breast milk, and more research is needed to assess the success of this effort. Some researchers are suggesting that less than optimum gut flora in the infant may be linked to a whole host of infant maladies including infections, a compromised immune function, digestive diseases, and even some cancers.

For the infant, breast milk offers a rich source of non-nutritional bioactive substances which assist in adaptation of the fetus to life after birth. Ironically, the more we learn, the more breast milk is promoted and acknowledged as the norm for feeding infants.

Thirty years ago, it wasn’t quite like that. Too many clinicians and mothers considered breastfeeding to be a rather archaic and bothersome way to feed the baby, especially in the hospital. Formula was considered so much “easier.” I have talked to countless women who struggled to keep a bottle out of their newborn’s mouth before they left the hospital. Even with mothers who want to breastfeed, 25% of those babies born in California are given a bottle of formula within two days.

There are renewed efforts to support breastfeeding, but still the number of mother/child dyads exclusively breastfeeding drops offs dramatically over the first six months of life. When I had my son 17 years ago, people were surprised that I was exclusively breastfeeding at 9 months of age. I gave the breast pump back at that time, not knowing any better and opted for a mix of breastfeeding and formula until Noah was a year of age when he suddenly weaned. I would have breastfed much longer if I knew then what I understand today.

WHEN WE FEED OUR BABIES, WE FEED THEIR GUT MICROBES TOO

What we eat determines the kinds of gut microbiota that thrives in our gut. It is thought that more whole foods with a high fiber content and resistant starch (from beans and legumes, nuts and seeds, vegetables, fruit and whole grains) feeds beneficial bacteria. The refined starches and sugars that are ubiquitous in the marketplace feed the other kind. This begs the question, how can we facilitate the growth of healthy bacteria in our baby’s gut when they begin to eat complimentary foods? Simple. Don’t feed refined, processed and sterile conventional baby foods.

The number one first food fed to American babies is rice cereal. The desire to reduce allergies is the driving force. Yet a paper published in the Journal of the American Academy of Pediatrics and well as positions taken by the World Health Organization state that there is little evidence that this practice has had any beneficial effect in reducing incidence of allergies.

Infant rice cereal is made from highly refined rice flour. It is reported to have a glycemic index of 95–close to sugar. How ironic if the refined rice flour used to make infant rice cereal has actually been increasing inflammation all along.

Americans have been seduced into thinking baby food comes from bottles and boxes in the baby food aisle at your local grocery store. Most people are surprised to find out that there was no such thing as commercial baby food until the 1920′s. Babies have been thriving on traditional foods prepared in the home for generations without all the refined and sterile convenience.

RETHINKING FIRST FOODS

Maybe we need to rethink first foods. The AAP currently recommends that meats, such as turkey, chicken, and beef, should be added as one of the first solids to the breastfed infant’s diet. The Academy goes on to explain, “Meats are good sources of high-quality protein, iron, and zinc and provide greater nutritional value than cereals, fruits, or vegetables.”

Other cultures include rich protein foods in their baby’s diets and rely on more whole foods cooks in gruels and soups often with broth and meat. In addition, other cultures seem to put more emphasis on vegetables, beans and legumes. These are foods with far more resistant starch, higher protein content and far less refined starch than the commercial infant cereals sold today.

Traditional foods are mashed or pureed so the beginning eater can take in the food. The homemade food has the potential to introduce more texture, more variety in flavors, and a wide variety of colors and other factors missing in commercial products–including the opportunity to nourish healthy microbes in a baby’s developing digestive tract.

The ability to introduce your baby to whole foods and the sensory richness of food are reasons I was immediately drawn to consulting for Mika Shino as she wrote her book, Smart Bites for Baby. I see how conventional baby food is produced to have the same texture and taste for all takers. With commercial baby food there is no opportunity to introduce babies to cultural foods with distinctive tastes, looks, colors and textures. There can be a disconnect between commercial baby food and what is usually prepared in the home. What happens when the baby is ready to take start eating the same foods as the rest of the family?

FEEDING BABY, FEEDING ME

Stanford pediatrician, Dr. Alan Greene published Feeding Baby Green in2009. In 2011 he launched a rather provocative effort titled, “WHITE OUT: End junk food for babies” and encourages other pediatricians to rethink their conventional advice regarding first foods. Dr. Greene proposes that highly processed commercial baby food may be one reason babies prefer and even refuse to eat anything other than refined starchy or sweet table foods. He also links the use of highly processed refined starches and baby foods to the growing incidence of obesity.

I have worked with families who complain that their children only eat pasta, rice and pizza. Many babies seem to live off of small bags of goldfish, graham crackers and other finger friendly foods–even if the parents attempt to purchase the whole grain, organic versions. The foods are supplying mostly highly refined starch, with and without the sugar. What we need is a return to introducing babies to real food cooked at home with all the color, texture, taste, and healthy microbes that come with eating close to the earth. We need to feed our children as well as we can feed ourselves.

CONVENIENCE VS HEALTH

Parents face an ever increasing array of prepared and processed baby foods– with or without the health halo of organic– but still sterile and highly processed . I’m wondering if that perceived convenience is worth the potential cost to our children’s health and well being. Often it can take less time and certainly less money to make your own.

In hindsight, despite breastfeeding my 17 year old for a year and making my own baby food, I know I would do things differently today. We didn’t consider gut microbes back then. I readily used formula to make my life easier after I turned in the breast pump. I didn’t think twice about using baby cereal. I readily used crackers and biscuits for snacks, even as I also introduced him to a colorful array of whole foods. I was doing everything I knew to enhance my child’s health with what I understood at the time. But I’d love a do-over. I would feed my baby differently today.

Highly processed and sterile infant cereal is still the primary first food recommended today. Health care providers and many parents are guided by the familiar. Processed and refined baby food have been institutionalized since 1920. But I am speaking to pediatricians at the California State American Academy of Pediatrics in Las Vegas this Saturday. If they haven’t already been convinced by Dr Greene, maybe they will rethink their recommendations after I put down the microphone.

Filed Under: Blog Tagged With: AAP, baby food, breastfeeding, color, digestion, Dr. Alan Greene, infant cereal, infant nutrition, junk foods, metabolism, microbes, Mika Shino, obesity, refined starch, rice cereal, sensory integration, solid foods, sugar, taste, texture, vaginal birth, WHO

Welcome to the “Post Pasteurian” Era

June 16, 2012 by Bonnie

It is all becoming clear: Eating less carbohydrate, more whole foods, a stronger intake of protein and fat, less carbohydrate, the magic of raw milk, the benefits of eating close to the earth.

Mark McAfee, owner of Organic Pastures, Fresno, CA

What we eat feeds the bacteria in out gut. They have a profound influence on our immune system, inflammation, how our body perceives hunger and satiety–and we can only guess how much more.

Research regarding the human microbiome hit scientific journals this week in what could be described as swarm tactics. This insight will trigger an explosion of new theories. It is a game changer.

THE MORE WE LEARN, THE LESS WE KNOW

Dr. David Relman, a microbiologist from Stanford says, “The whole business is humbling. It seems like the more we learn, the less we know.”

Ironically, I have been searching for this piece of the puzzle for years. The clues have been accumulating, first from observing myself, and then my clients.

Back in the early 90′s I started counseling clients to eat less carbohydrate (especially less refined sugar and starch), more protein, and more healthy fats. I thought I was helping them manage their insulin response to food. I still do. But now I realize we were also feeding the bacteria flora in their gut.

EXPLORING INSULIN RESISTANCE

It seems I have always struggled with food. I remember blowing up like a balloon when I overate. I could lose weight readily when I stopped eating, leading to a nasty eating disorder in my teens. Much later on I realized a higher protein diet with far less carbohydrate was better for me. In the late ’80s this behavior was blasphemy. High carbohydrate, low fat eating was the diet of the day, but it didn’t work for me.

After regaining my health and my sanity, I started digging into the research and published my first paper regarding insulin resistance. (SCAN PULSE, Fall/1995) For over 20 years it has given me great satisfaction to share my insight.

Most of the time people benefit when they shifted to more whole foods, less refined sugars and starches, more protein and healthy fats. Good enough. But there were always curiosities that I couldn’t explain.

CONNECTING THE GI DOTS

After shifting his diet, one client came in complaining that he had just bought a case of Prilosec to treat his GERD (What used to be called heartburn), and he didn’t need it anymore.

Other clients would surrepticiously tell me about their bowel function improving. They enjoyed more regularity and no longer complained about constipation or diarrhea.

I remember one client with severe colitis. He was horribly depressed as he couldn’t leave his home and was in danger of losing his business. He slowly regained his health. We knew we had identified the culprit when he went to the movies one night and ate a bag of candy. The next 48 hours were miserable.

I had one young client see me for weight loss. She also had Crohn’s disease. She lost weight and her symptoms improved. Little did we know that an approach to food to improve her metabolism was also influencing the microbiota in her gut.

A 17 y/o male came in complaining about severe vomiting, especially in the morning. Doctors had no clue. We cleaned up his diet, added enough protein and the vomiting stopped.

LESS INFECTION, LESS INFLAMMATION

Other clues started to stack up. One client with interstitial cystitis struggled with repeated bouts of antibiotics, but no sustained benefit. She got better eating close to the earth. Another client reported incessant urinary tract infections, but they subsided eating more protein and fat, less carbohydrate.

I watch my own son. His body reacts intensely to what he eats. I know when he is eating more carbohydrate than he can handle. His body swells. His demeanor changes. He is ravenous and can’t get satisfied. Eating fewer grains and less refined sugar is critical for his well-being–despite the addiction-like attraction to just these foods.

EATING FOR THE MASSES (of bacteria in our gut)

What we eat influences how our body uses fuel. I am beginning to fully appreciate how our food influences the billions of bacteria residing in our body. This is especially true of bacteria in our gut.

I introduced raw milk into my family’s diet a couple of years ago. I needed to try something. My son’s GI tract distress was intolerable–for me. I could hardly enter his room. I thought about pro-biotics and prebiotics, but was turned off by the high prices. I wanted to try something more organic. Was there something we could be eating?

INTRODUCING GOOD BACTERIA TO OUR GUT

Raw milk entered our food supply. The impact was immediate. Less gas, less bloating, less stench. I often wonder if we are more like cows than we think. Feeding cows too much grain causes them to bloat as well.

I became a devotee of Organic Pastures raw milk. I appreciate the fact that the cows graze on pasture and the cows and the milk are regularly tested. Mark McAfee is the owner and trained as a microbiologist. It seems Mark spends every waking moment heralding the benefits of healthy bacteria in our gut.

A POST PASTEURIAN WORLD

In the Pasteurian world, all bacteria is destroyed. We sterilize, pasteurize, and sanitize our food supply to our own detriment. We need to embrace a post-Pasteurian world view, especially in regards to our food supply. We can’t continue to rely on a seek and destroy orientation to the bacterial world.

Industry needs to rethink how we grow and manage our food. Assaulting the sins of mass production with massive doses of antibiotics is a mistake

Regulatory agencies need to trust science to monitor microbes, not just seek to eradicate them. Zero tolerance needs to be a thing of the past.

We all need to learn to work with the body–and the billions of bacteria that live symbiotically with us.

What we eat has a huge influence on our health and well being. The quick fix experts will redouble their efforts touting the benefits of probiotic and prebiotic supplements. They are probably a useful Band Aid, but my guess is that our overall diet counts more.

We are inundated with an obscenely processed and adulterated food supply. We need to figure out how to survive abundance. A good starting place is consuming more whole foods like beans and legumes, fresh fruits and vegetables; maybe some whole grains, but not too much; adequate protein, and enough healthy fat. We need to embrace healthy bacteria from the right kind of raw milk and fermented foods. We all need to eat closer to the earth.

Filed Under: Blog Tagged With: addiction, antibiotics, appetite, bacteria, bloating, colitis, constipation, crohn's, diarrhea, fermented food, gas, GERD, gut, hunger, immune function, inflammation, insulin resistance, microbiome, organic pastures, pasteurization, prebiotics, probiotics, raw milk, reflux, resistant starch, sugar, weight

Losing Weight Is Not a Math Problem

May 7, 2012 by Bonnie

How many times have you read “a calorie is a calorie?” Countless weight loss studies test different diets and everyone loses weight. Calories are drastically limited in most of the diets. At a deficit of 500-1000 fewer calories a day, the diets typically allow people 50-75% of recommended intake.

Of course everyone loses weight. The researchers conclude that it doesn’t matter what diet you use, all of them will work equally well. So the mantra lives on, “Eat Less, Exercise More.” But losing weight is not merely a math problem.

In more sophisticated studies, some diets works better for specific individuals. In 2007 research by Chris Gardner (a nutrition researcher at Stanford University) found that a higher carbohydrate diet helped insulin sensitive people to lose fat weight more effectively. The higher protein diet worked better for people who were insulin resistant.

Researchers with David Ludwig at Harvard University studied a group of overweight adolescents. The teens eating lower glycemic carbohydrates (more whole grains, fruits and vegetables, beans and legumes) lost more fat weight than those eating a calorie restricted low fat diet with all the usual fare.

The test subjects ate whole grains, not refined. They ate oatmeal, not sugared refined cereals. They ate more fruits and vegetables. Not chips, pretzels and other refined snacks foods. They drank water, not sodas.

The teens eating more whole foods also sustained a lower BMI even six months after the research ended. The calorie restricted subjects regained the weight lost—and more. That’s a familiar scenario for too many people.

DIETING AND DISORDERED EATING

The endless struggle to lose weight has cultivated a population of yo-yo dieters, chronic dieters, and many people with disordered eating and diagnosable eating disorders. What’s missing is an approach to food that works with the body, mind and soul of the person who is trying to lose weight. Each person needs an approach to food that works for them.

Ironically weight is not a good measure of success. Many in the medical and public health community want to believe weight is a useful way to measure health. It isn’t. Thin people develop heart disease, hypertension, diabetes, digestive disorders, and cancer. The idea that body fat drives the disease state is one of the great distortions of modern medicine.

WHAT’S DRIVING WEIGHT GAIN? WHAT’S DRIVING DISEASE?

What we eat influences our body in ways not anticipated by people who think obesity is a math problem. For most of my clients, poor metabolic health precedes the diagnosis of disease regardless of their weight.

When people eat poorly, the body adapts—and not in a good way. A diet rich in refined starches and sugar can increase insulin resistance—an underlying condition linked to diabetes, heart disease, cancer, and more.

In addition, eating refined sugar and starch promotes a different bacteria flora to reside in our digestive tract. Eating excessive refined sugar and starch promotes the secretion of gut peptides that influence appetite. Certain gut peptides, like ghrelin, signal the brain and compel us to eat more. It is even thought that the gut microbes linked with refined sugars and starches can promote fat gain.

THERE IS NO ONE RIGHT WAY TO EAT

Ideally your food plan allows your body to metabolize both fat and glucose effectively for fuel. It allows you to feel satisfied after eating. It provides you with energy needed to complete the tasks of your day—both work and play.

A successful approach includes foods you enjoy, foods that are readily available, and foods that you can afford. The actual mix of food that works for you may be very different than the mix of food that works for someone else.

WHICH DIET?

Too many people ask me what kind of diet I support. Is it Paleo? Raw Foods? Vegan? Do I promote Weight Watchers? The Zone? Pritikin?

This question reveals a distorted understanding of the process. Decades of dieting has cultivated a belief that there is one right way to eat. You just have to find it. People spend too much of their lives trying one diet after another Sometimes they get stuck trying the same one over and over and hoping for a different result.

Ironically the medical world also needs to abandon the idea that there is a single dietary approach to treat any one disease. It is critical that we start treating the patient, not the diagnosis.

There should be is no such thing as a diabetic diet, as if every diabetic will benefit by the same exact food plan. The same goes for diets promoted for any single disease, as well as weight loss itself.

AN APPROACH TO FOOD THAT WORKS

Magical thinking distracts people from the real task at hand: cultivating an approach to food that works. Too many people try and eat like a thin friend, a thin sister or the biggest loser. That food intake may actually make everything worse. It may be so unsustainable that you soon abandon the effort.

We can do better. Anyone who struggles with their weight or their health deserves to figure out an approach to food that works for them.

Filed Under: Blog Tagged With: appetite, bacteria, cancer, diabetes, diet, exercise, fat, ghrelin, glycemic index, gut peptides, heart disease, obesity, Paleo, Pritikin, resistant starch, sugar, Vegan, weight loss

A Sweet Battle: Is high fructose corn syrup nutritionally the same as sugar?

March 24, 2012 by Bonnie

Nobody is claiming white table sugar is good for you, but HFCS stands accused of being much worse. Three days ago the LA Times reported that sugar producers filed suit against the Corn Refiners Association for false advertising. The Corn Refiners Association is known for ads that claim “high fructose corn syrup (HFCS) is nutritionally the same as table sugar” and that “your body can’t tell the difference”. This controversy has roiled scientific conferences for years. It is hotly debated in corporate boardrooms, and now the courts get to weigh in.

THE DIFFERENCE BETWEEN SUGAR AND HFCS

Much of the confusion lies in that both products–white table sugar and HFCS–are made from two basic simple sugars known as monosaccharides: glucose and fructose. In white table sugar one molecule of each is bound together to make a disaccharide called sucrose. The glucose and fructose molecules exist in a one-to-one ratio. Commercial sources of sucrose include sugar beets and sugar cane. This is the conceptual essence of “natural”–the plants make the sucrose.

To make HFCS, corn syrup is manipulated in a factory to create different ratios of glucose to fructose. The most common formula in food manufacturing is 55% fructose and 45% glucose, but there are formulas for up to 90% fructose. This is most certainly not “natural”.

YOUR BODY KNOWS THE DIFFERENCE

HFCS is not the same nutritionally as sucrose, and your body certainly knows the difference. Fructose is metabolized very differently than glucose. All cells can use glucose for fuel. Fructose must first be metabolized in the liver and converted to glucose. When high levels of fructose are consumed, the excess energy is laid down as fat in the liver. This process can progress to fatty liver disease, non-alcoholic steatohepatitis (NASH), and eventually to cirrhosis.

It is possible to over consume fructose without HFCS. This maybe difficult with actual fruit, but people do it all the time with excessive intake of juice. Juice is just not the same as the fruit itself.

Juicing means most of the fiber is left behind. While someone would rarely eat more than one orange, a small 10 oz glass of juice contains the calories and fructose of 2 1/2 oranges. I have witnessed restaurants serve 20-24 ounces of juice as a single serving and ask if someone wants a refill.

HFCS has become the primary sweetening of all sodas, fruit drinks, sweetened teas, energy drinks and the like. It is cheaper than table sugar. The number of these products has swelled enormously over the years. Just take a look at your local grocery-convenience-liquor-drug store. Many producers have the nerve to promote these products as “health foods” and have designed labels to convey a fresh and wholesome image.

HFCS is also used as a filler, thickener and taste enhancer in all sorts of processed foods, from salad dressings and peanut butter to frozen dinners and condiments. It is everywhere.

ALCOHOL WITHOUT THE BUZZ

Endocrinologist, David Lustig, MD, of UC San Francisco has taken to calling HFCS as “alcohol without the buzz”. He writes and speaks vehemently about the consequences of our relatively recent experiment with this cheap and ubiquitous source of sweetening in our food supply. HFCS didn’t start entering our food supply until the 1970′s. It is no coincidence that statisticians citing increasing rate of childhood obesity use 1970 data as a starting point.

Currently HFCS holds “generally regarded as safe” (GRAS) status according to the FDA. A National Institute of Health website discussing NASH states the cause is unknown and there is no known cure. Just how long before some of this changes?

Filed Under: Blog, Uncategorized Tagged With: childhood obesity, corn refiners association, corn sugar, David Lustig, diabetes, fatty liver, fructose, glucose, high fructose corn syrup, NASH, natural, NIH, nonalcoholic steatohepatitis, obesity, sugar

GREEK YOGURT OFFERS 2-3 TIMES MORE PROTEIN, LESS SUGAR

February 26, 2012 by Bonnie

February 26, 2012

“Greek yogurt sales stirring up the food industry” says Tiffany Hsu of the LA Times. The popularity and rise in sales of Greek yogurt are truly remarkable. Too bad the reporter only side-swiped the issue by reporting Greek yogurt is “perceived to be filling.” It is more filling and it’s the protein.

Protein has a profound capacity to enhance satiety–the feeling of being satisfied after eating. Conventional breakfasts of cereal, bagels, muffins or pastries (mostly carbohydrate and fat) leaves too many eaters wanting–and feeling hungrier all day long.

It is no coincidence that the incidence of obesity and diabetes swelled during the reign of high carbohydrate low fat diets. People ended up eating more when they didn’t feel satisfied.

GREEK YOGURTS OFFER MORE PROTEIN, LESS SUGAR

Enter Greek Yogurt with 16-20 grams of protein and more per serving, often with a fraction of added sweetening. The better balance of protein and carbohydrate –with or without the fat–means feeling satisfied longer. I have one client who recently told me that learning about Greek yogurt was worth the time and money spent on nutrition counseling all by itself!

A cup of plain yogurt contains 8-12 grams of lactose, the natural sugar found in milk. Plain yogurts only contain the lactose. Flavored Greek yogurts boast a mere 15-20 gram of total sugar. That means a mere 1-2 teaspoons of added sugar compared to the 1-2 tablespoons of added sugar found in conventional flavored yogurt. And most conventional yogurts contribute only 6-7 grams of protein.

Greek Yogurt is popular because of the protein. Despite the added cost, Greek yogurt is a quick and convenient breakfast, snack and source of protein at any other meal.

The LA Times article mentions Ben and Jerry’s foray into Greek yogurt frozen desserts. This should be interesting. Will the added protein offset the added sugars? I’m not so sure. If you try it will you let me know?

Filed Under: Blog Tagged With: Ben and Jerry's, breakfast, carbohydrate, dessert, diabetes, fat, greek yogurt, obesity, protein, satiety, snack, sugar, yogurt

The Elephant in the Room: Fast Food (Doesn’t) Make You Fat

October 18, 2011 by

Probably the most stated and universally accepted nutrition sound bite is this one: Fast Food makes you fat. People believe all the public health hype. If you frequent a fast food establishment, you are inherently eating bad food, food that will have your cholesterol soaring and your waistline expanding. Hog wash.

What makes perfectly intelligent and often well educated people accept and believe such a ridiculous sound bite? How does one sector of the food environment get so much grief about its food when obesity and health issues linked to food are so enormous (pun intended)? The incidence of obesity in America– and child obesity in particular– is a bigger and more complex problem than any one food source.

GOVERNMENT GOVERNING BADLY

I have sat in a few city council as well as Planning and Land Use Meetings (PLUM) in Los Angeles the last few years. I was invited to speak at a high school event in San Francisco with Supervisors Eric Mar and Bevan Duffy. I may be naïve, but I am appalled at the lack of transparency and the hidden agendas.

The government types seem to universally accept that fast food is the culprit. Fast food is making everyone obese. This argument wouldn’t be so specious except lots of thin people eat fast food. Many obese people don’t eat fast food. Even the “average” customer at McDonald’s frequents the restaurant just over 2 times a month. Are those two meals a month really making so many people obese?

My cynical self sees the elephant in the room. Government types have jumped on the fast food bashing bandwagon to further their agendas. They see a universally misunderstood, emotionally charged issue that can be manipulated for their own benefit. They are running fast and loose with the facts. Overwhelmed, underfunded and outgunned by the food industry, desperate public health entities lunge at any opportunity they can to gain a foothold.

PEOPLE WANT TO BELIEVE THE MYTH: SIT DOWN RESTAURANT FOOD IS HEALTHIER

Earnest public health advocates as well as dedicated clinicians continue to pound the point home: Fast food makes you fat. Avoid fast food. Avoid fried food. Avoid sugar. Cut down on salt. Too bad fast food establishments aren’t the only places you can buy “fast food”, food high in sodium, sugar, and fat.

In 2005 I looked at what the so called “healthier” sit down restaurants were feeding the kids. After reviewing 14 kid’s menus from local neighborhood cafes and chain restaurants the evidence was clear. These sit down restaurant served children the same food as their quick service counterparts.

Overwhelmingly the menus offered hamburgers and fries, some form of fried chicken strips and fries, pizza, and the like. Less than 7% of the restaurants offered a fruit or vegetable on the menu. Often milk wasn’t an option for the lower cost meal. Resorts and hotel restaurants fared even worse. Less than 5% of their kid’s menu options offered a fruit or vegetable.

Sit down restaurants often offer all you can drink sodas and free dessert. I did not assess serving size, but at a glance I know that most restaurants do not following USDA guidelines regarding calorie intake suitable for a child. When he was young, my child ordered his share of kid’s meals. My guess is that very few of these establishments put any thought into the amount of energy they serve the kids.

NUTRITION ON THE MENU: WILL IT CHANGE BEHAVIOR?

In January of 2011 we are supposed to see nutrition information available on every menu of every restaurant with at least 20 sites in California. Early evidence shows that this information could be a game changer.

Many popular chain restaurants serve meals or entrees that hover between 1000-2000 calories each. Early in the game, one popular national chain known for generous portions jumped the gun and listed their four digit entrees, noting the calories directly on their menu and website. Entrees offered anywhere from 1000, 2000, even 3000 calories each!

Rumor has it that sales dropped dramatically. Within months new menus without the calorie amounts were printed. Most calorie information was removed from the website. Now a separate reference book is available with the information for those who ask.

Some establishments have devised ingenious and disingenuous ways to deceive the public. I have seen menus list all the items separately—even when they are usually served together. It is common that the 900 calorie sandwich is listed in one location. The 700 calorie French fries are listed someplace else. The beverage calories are listed but ultimately unknown. There is no telling how many free refills you will accept.

Typical portions today are enormous. We have a distorted sense of value. We want to believe more is better. It is not unusual to be served food on a platter. The platter for my meal at one local bistro looks suspiciously similar to the platters my mom would use to serve a family of eight.

One restaurant chain had the nerve to try to identify their 1000+ calorie meals as “2 servings”.

EATING OUT MAY NOT BE THE ONLY PROBLEM

The National Restaurant Association reports that 50% of every food dollar is spent away from home. Research says people eat more calories at restaurants than at home, but I wonder.

Does the research consider just the meals eaten at home? What about the snacks? We are no longer a country that eats at a table. Snacking accounts for 40% of food intake for children and many adults. I suspect that most people probably eat a modest meal at home. I think most people don’t cook much. They are probably assembling a quick or simple meal because they don’t have the time, energy or desire to put together a full dining experience.

Breakfast is a bowl of cereal, a yogurt, a muffin or a piece of toast. Lunch may be a sandwich or a salad, possibly with a piece of fruit. At their first session most of my clients report that eat very little food before “the witching hour”, about 3 or 4 o’clock in the afternoon.

When you eat very little throughout the day, the body provides additional energy from stored carbohydrate (glycogen) in the liver. Every time you feel hungry during the day and put off eating your body ends up tapping into this reserve. By the witching hour, the calorie cheaters have tapped out the stored energy and hunger hits and sticks with a vengeance.

Sometimes the feeding frenzy begins before anyone even thinks of dinner. Snacks come out of hiding in a desk drawer or purse. The office kitchen is scanned for leftover bagels or donuts. Somebody’s desk has a jar of candy available for the taking. There is an organized run for “coffee”, a euphemism for the highly caloric beverages that are served at coffee houses everywhere.

I know many clients who come home from work and start eating the minute they enter the doorway. There are snacks before dinner. Anyone who cooks and assembles food can be found munching on the ingredients while they prepare their plate. All too often dinner extends into the living room after dinner with a serial intake of snacks in front of the television. I wonder if the researchers are counting all the calories consumed at home or just those consumed at the dinner table. For these folks “dinner” lasts from 5 until 10 PM.

ABUNDANT, HIGHLY ADULTERATED FOOD IS EVERYWHERE

Every supermarket, convenience store, liquor store, pharmacy, hospital cafeteria, entertainment venue, and vending machine sells food that is highly refined and adulterated.

Increasing rates of obesity, diabetes, heart disease and cancers are true public health crises. Children born today will likely not live as long or with the same health as their parents. We cannot afford children with type II diabetes. We cannot afford young adults on dialysis. Medical care is not cheap. We cannot afford the excessive amount of cheap, tasty food that we are offered everywhere, all the time.

FOOD IS (relatively) CHEAP

Our food supply has radically changed during the last half century. In 1947 the average household spent 27% of their after tax dollars on food. Today families spend between 9-12% of their net income on food. Food is relatively cheap. But not all food is cheap in the same way.

Fresh fruits and vegetables cost more. Between 1985 and 2000, USDA data tells us that the cost of fresh fruits and vegetables increased 118%. During that same time period the cost of sodas increased 20%.

USDA farm policy continues to subsidize wheat, corn and soy. The exact ingredients used to make highly refined and adulterated foods. It is government policy that makes bread, cookies, candy and soda so cheap. How ironic that these refined carbohydrates are now considered to be the problem, driving the obesity epidemic even more than fat intake.

Even beef and milk are relatively cheap to buy. Subsidized corn and soy are used as animal feed in order to maximize profits at the feed lot. These animals are not allowed their natural diet in order to allow us a cheaper, fattier, less healthy product at the market. For years I have had a hard time trying to rationalize a national farm policy that flies in the face of national health policy.

BUYING FOOD AT THE SUPERMARKET DOESN’T MAKE IT HEALTHY

Supermarkets are no refuge. Average supermarkets offer 48,000 items. One study assessed the nutritional quality of supermarket food. Foods earned one star for good food choices, two stars for better choices and three stars for the best choices. The two nutritionists who designed the program did not assess candy, gum or alcohol. Still, less than 25% of the products offered earned even one star.

Supermarkets cater to our fast paced, busy lives. Convenient and pre-prepared food is the fastest growing sector in the marketplace. Over ten years ago I started asking my clients if they cook or “assemble”.

Less floor space is dedicated to basic whole foods. Raw produce, dairy and meats fill up a miniscule percentage of a market’s footprint. Even markets that cultivate a healthier image make most of their profit on the value added items, not to mention all the supplements and so call “health foods” that are highly refined and processed themselves.

CONFUSING THE ISSUES

The truth is that the obesity and health challenges we face as a nation are daunting. It is seductive to latch onto absolute sound bites declaring “fast food is fat food” like a tenacious bull dog. But there is trouble ahead. In the face of mounting evidence that dispels the myths, public health and government bull dogs are not letting go.

When undue resources are directed towards demonizing fast food, little attention is paid to the dismal state of our food supply everywhere. I have clients wanting to lose weight, diagnosed with any number of metabolic diseases, who don’t understand why they are struggling. Sometimes they boast, sometimes they lament: “But I don’t eat fast food.”

Fast food doesn’t inherently make anyone fat. Fast food is not inherently more caloric, higher in fat or more refined sugar than food served anywhere else. It is not even served in the largest portions.

When fast food restaurants serve vegetable and fruit salads, grilled chicken sandwiches, one percent milk and other “healthy” fare, how can people continue to believe that fast food inherently serves food that is less healthy than every other food venue?

EMBRACING EDUCATION, CELEBRATING CHOICE

People with influence continue to misinform the public at their own peril. They will soon be exposed as the opportunistic and short sited “man behind the curtain that they are. We can only hope the shrill pundits attacking fast food are as gracious in their exposure as The Wizard of Oz.

Current research is already questioning the high carbohydrate, low fat mantra. Renown nutrition epidemiologist Walter Willet has stated that the research shows refined sugars and starches are likely much more of the problem. There is even rumbling that saturated fats are not as problematic as once thought, especially the saturated fats derived from animals that consume their natural diet. These fats are rich sources of omega 3 fatty acids, conjugated linoleic acids and other healthful nutrients.

FOOD QUALITY STARTS ON THE FARM, FINISHES IN THE KITCHEN

We are learning that the quality of food, how animals are fed and how crops are grown impact the nutrient density of that food. When soil is nurtured will the full spectrum of nutrients from composted foods and waste products, the entire soil ecology improves. The activity of worms and other insects enhances the viability of the soil. Grass grows better, animals feed better, crops grow better, and we feed better.

I appreciate that eating food in its most natural state reduces intake of problematic ingredients like high fructose corn syrup and partially hydrogenated oils (trans fats). I have learned that telling people to avoid salt during cooking is futile. Salting foods appropriately when cooking is not the problem.

Seventy percent of all sodium consumed comes from highly processed and refined items. Some the most significant sources of sodium don’t even taste salty. Bread, pastries and cereal contribute surprising amounts of sodium in the diet because people eat these foods frequently.

In sum, every fast food establishment has the opportunity to prepare and serve excellent food. There is nothing inherently unhealthy about fast. While the slow food movement has its merits, my guess is that most proponents of eating “close to the earth” have been stuck eating on the run. There is no reason to shun fast food done well.

THE NUTRITION MESSAGE NEEDS TO CHANGE

Convenience and taste are the two top factors driving people’s food choices. Quick service restaurants are here to stay. The message needs to change. We need to encourage fast food patrons to make judicious food choices at fast food restaurants. We need to encourage everyone to make judicious food choices everywhere. We need to help people avoid a polarized relationship with food.

It serves no one to make people feel guilty about eating anything other than “healthy” food. Guilty people end up pretending. They become opportunistic eaters, taking advantage of every treat and extra serving offered. They become closet eaters, even their best friends don’t know. They lie to their doctors, they lie to their dietitians, they lie to their families, and to themselves.

It’s time to be far more honest about food. It’s not where you eat. It’s what you eat when you get there.

Filed Under: Blog Tagged With: cholesterol, farm bill, fast food, fat, government, kids meals, National Restaurant Association, obesity, public health, restaurants, saturated fat, sugar, supermarkets

SPIN: The Misinformation of Sound Bite Nutrition

October 18, 2011 by

Stone Hearth Newsletters leads with a story titled, “We have no idea what, or how much, we are eating: new study” Click on the link and you are sent to a story in MedPage Today titled “Recipe for Healthy Eating Not Easy to Stick To” I would have never guessed they are reporting on the same story.

While Stone Heart’s title is basically sensationalistic and misleading, I find fault with both leads. Med Page today pretends that it’s author’s version of healthy eating is the only one. In addition, Med Page quotes a senior Consumer Reports Health editor who is obviously confused. Since when is dieting the same thing as healthy eating?

Nancy Metcalf, senior editor at Consumer Reports Health (CRH) said, “We were surprised to find that very few Americans weigh themselves and count calories, two strategies that can help dieters stay on track.” I wonder why editors at CRH think that people need to weight themselves or count calories to be healthy eaters.

COUNTING CALORIES, WEIGHING SELF NOT NECESSARILY HEALTHY BEHAVIORS

In over 25 years of private practice I have learned that restrained eaters and chronic dieters often count calories and weigh themselves every day. Most of my clients with eating disorders count calories and weigh themselves at least once a day. Neither behavior is necessarily a marker of health.

The researchers also asked people about other food behaviors. How many servings of fruit and vegetables was probably on of the more reliable indicators. About 58% report getting five or more servings of fruit and vegetables a day. That’s actually impressive. Years ago the average intake was 1.2 servings a day.

WHAT FOOD BEHAVIORS ARE HEALTHY?

The rest of the report summary takes an interesting spin. The report states that about half of the population isn’t careful about limiting unhealthy foods. The language of article is negative, disparaging that more people don’t follow a fairly narrow definition of healthy eating.

The MedPage article states “Just 54% of people surveyed said they watch how many sweets they eat every day or on most days, while 51% said they limit fats (my italics). Is that really so bad?

HOW MUCH SWEET IS TOO MUCH?

Sweets are not necessarily taboo. Eating a square of chocolate or cookie after a meal doesn’t negate the healthfulness of the meal. Without some sense of quantity and frequency, comments like this lead people to believe the goal is to eat no sweets. This kind of thinking is a sure fire set up for “what the hell effect.” Someone trying to be healthy may feel like they “blow it” by eating one cookie, only to give up in frustration and eat the entire box.

This is the difficult thing about trying to ascertain the nature of a healthy diet. Some people eat well while they continue to consume a variety of foods with added sugar each day. Others can’t get away with even a small sweet once a day. It is virtually impossible to set a “reasonable” limit that works for everyone without being unnecessarily restrictive for some and overly generous for others.

WHAT ABOUT DIETARY FAT?

Both the amount and types of dietary fat recommended to consumers are debated these days. Scientists, researchers, and clinicians alike are questioning the 40 year old mantra to reduce fat intake. Both Walter Willet, PhD of Harvard and Andrew Weil, MD currently question the decades old advice. In fact, both have stated that fats are not the problem here. They believe real issue is excessive sugar and refined starches.

In December, 2010, Gary Taubes published “Why We Get Fat”. It also refutes the low fat mantra, explaining how a high carbohydrate, low fat diet can increase the risk of obesity as well as incidence of diabetes, cardiovascular disease and other inflammatory states.

There is plenty of evidence that there is not one right or healthy way to eat. The sooner public health advocates, consumer groups, researchers and clinicians come to recognize the need for more sophisticated nutrition advice, the better. In the meantime, the world of soundbite nutrition continues to polarize and confuse consumers.

Someone moved the cheese. We can no longer be preoccupied with yesterday’s problem, trying to determine the specific nutrient parameters of a healthy diet. We need to move on to the challenges we face today. How can we help individual consumers figure out an approach to food that is right (healthy) for themselves? That is a much different, and a much more challenging, puzzle to solve.

Filed Under: Blog Tagged With: Andrew Wiel, calories, Consumer Reports, fat, Gary Taubes, Med Page, Stone Hearth Newsletter, sugar, Walter Willett, weight

2010 USDA Guidelines: Maybe we need to change focus

October 18, 2011 by

The 2010 USDA Dietary Guidelines were released this week. In an attempt to establish nutrition guidelines for the masses of overweight, unhealthy Americans these guidelines attempt to curb our appetites and nudge Americans towards more healthful diets. In ninety five pages of committee speak, the messaging begins to sound like Charlie Brown’s teacher. Wah, Wah, Wah.

Declaration after declaration drones on about how we should be eating. Decrease sugar, eat more fiber, decrease saturated fat, consume less sodium, use only reduced fat dairy, eat more fruit and vegetables, stop drinking sodas. I don’t like the tone or most of the message.

If I am tuning out, how do most Americans react to the authoritarian messaging of these guidelines?

For all the documentation, the biggest void in the document is not enough said about individual needs. There is no one right way to eat. There is no one universal diet that is right for all Americans. The attempt to coddle together a list of nutrition recommendations for the public is a lofty goal, but ultimately misses the mark for many individuals.

I wonder why the focus in only on individuals. There is much wrong with how our food is grown and processed. There are many problems with how food is served. I propose a few dietary guidelines for people preparing food.

DIETARY GUIDELINES FOR FOOD PRODUCERS

1. Serve a balance of protein, carbohydrate and fat at every meal.

Some people need more protein, others benefit from more carbohydrate. Let one version serve very small amounts of protein, others more. Up charge for the difference. Fill half of the plate with produce. Vary the amount of starch–more with less protein, less with more protein.

2. Serve portions that meet our needs for a meal. Aim for 600-800 calories a plate.

Average Americans are recommended between 2000 and 2700 calories a day for food. Most people snack through the day. There are not many of us that need 1500-2000 calories in a meal. People who need more calories can add an appetizer or dessert.

Americans spend half of their food dollars eating away from home. Eating out is no longer a rare treat. Eating out is a way of life. Our bodies are bearing the weight of food served like it’s Thanksgiving multiple times a week.

3. Use salt judiciously to enhance flavor, not to make food taste salty.

Salt is an amazing seasoning agent. It allows flavors to come alive when it is used properly. Most cooks have lost or never developed the appreciation for adding just enough to make the flavors of the food “pop”.

Don’t let anyone season the food that doesn’t have a more sophisticated palate. Our taste buds will adjust. Ultimately we will reap the benefits of a lower sodium intake without the draconian measures suggested by some public health groups.

4. Use whole foods and prepare them well.

It doesn’t serve Americans to consume highly processed and adulterated food. It is difficult to eat well when more than 75% of our food supply in the supermarket is not considered a good food choice.

I wonder what would happen if the reverse was true? It would be a different shopping experience if only 25% of the food in the marketplace was considered less than a good food choice.

5. Take time to purchase food that is grown sustainably and locally.

Buy from farmers, ranchers and suppliers that offer ingredients supporting stewardship of our oceans, soils and air. Sure the products will cost more, but health care is even more expensive.

Don’t let the canard of an inadequate food supply throw you off track. America currently produces 4000 calories per capita. We don’t need as much as we produce. Excess calories either become waste or contribute to our waists.

6. Don’t get seduced into thinking more is better.

Adding more sugar, more sodium, and more fat doesn’t necessarily make food more delectable. Making food more entertainment than nutrition has led us down a slippery slope.

7. A special note to food scientists: Please be a little more skeptical when inventing new ingredients.

So far, the production of hydrogenated fats, high fructose corn syrup, artificial sweeteners and the like have been less than beneficial in most arenas except the manufacturers pocketbook. It is time that the food technology industry bears more responsibility in showing that a product first does no harm.

8. Fully integrate the cost of cheap food into the actual price of these products.

When food production negatively impacts the soil, the air, or the waterways, these products should carry the cost of repairing the damage, or change farming and manufacturing practices.

For starters, we need to wean farmers off artificial fertilization. It is not OK that ocean regions the size of Texas become hypoxic after spring rains. The Gulf of Mexico cannot support marine life for months after artificial fertilizers are carried off the farm. The toxic brew of nitrogen, potassium and phosphate travels down the Mississippi to wreak havoc with the gulf’s ecosystem.

Next, USDA needs to stop subsidies for the very crops that are used to produce adulterated ingredients that are part of the problem. USDA subsidizes the corn that makes high fructose corn syrup (HFCS) used to sweeten sodas, and a mind boggling array of products. HFCS is used in everything from cake frosting to ketchup.

USDA subsidizes the soybeans that produces soybean oil, especially the partially hydrogenated kind. USDA subsidizes grains that produce the highly sugared cereals, snack foods and pseudo-bakery confections that contribute to our increasing girth and poor health.

FOOD’S RIGHTFUL PLACE

It is time to allow food it’s rightful place. Food is an amazing and rich medium. Food is tasty and immediately gratifying. Food can be social or solitary. Food is cultural and it can be novel. Food is both nurturing and nourishing. We don’t lose any of that experience when we eat well. In fact, eating closer to the earth can elevate the experience so that food is truly satisfying.

Filed Under: Blog Tagged With: carbohydrate, fat, fiber, food technology, HFCS, protein, salt, sodium, subsidies, sugar, USDA

Dueling Dietary Guidelines: The Weston Price Foundation challenges the USDA

October 18, 2011 by

March is National Nutrition Month. Recently both the USDA and Weston Price Foundation published dueling dietary guidelines.

People are confused about food. Too many studies, too many experts, and all sorts of contrary ideas are floated as evidence of the right way to eat. Makes me wonder if there is a single “right” way to eat that works for everyone.

The Weston Price Foundation (WPF) threw down the gauntlet on February 14, 2011, introducing “Healthy 4 Life” in direct competition with the recently released USDA 2010 Dietary Guidelines. Why are food recommendations so controversial?

WPF followers see significant harm in the current approach recommended by the committee who drafted the USDA guidelines. They are not the only ones heaping criticism on the latest rendition of the guidelines. Comments by Walter Willet and Marion Nestle charge that USDA guidelines are overly influenced by commercial and corporate interests. Both Drs. Nestle and Willet contend that food interests are very powerful in this country. They say it is all a matter of following the money.

USDA RECOMMENDATIONS FOCUS ON CALORIES AND NUTRIENT-DENSE FOODS

USDA opens with two over-arching concepts. The first is a statement about Calorie balance and sustaining a healthy weight, basically committee speak for too many Americans are fat and need to lose weight. WPF states that meeting energy needs with recommended whole foods eliminates the need to count calories and will naturally lead to a healthier weight.

Secondly USDA recommends focusing on consuming nutrient-dense foods and beverages. WPF also encourages eating nutrient dense food, but their Food 4 Health guide looks remarkably different than the USDA 2010 Dietary Guidelines. Both organizations herald experts in their respective disciplines. How do they come to such differing positions on something as basic as what we eat?

WHAT IS A NUTRIENT DENSE FOOD?

USDA tends to focus on nutrients and nutrition science. USDA is very quantitative and evidence based. The Weston Price Foundation hones in on the quality of the soil, methods of food production and food preparation.WPF reinforces the value of eating traditional foods in a traditional way, pointing out that the last 40 years of nutrient based science parallels alarming increases in lifestyle disease states and obesity in this country and the world.

Both groups encourage the consumption of fruits and vegetables. USDA presses for more fiber, WPF presses for eating whole foods, organically grown.

WPF encourages beans and legumes in the diet as a compliment to animal products. USDA Dietary Guidelines suggest eating beans and legumes as a healthy substitute for animal products, which they say contribute excessive fat, saturated fat and cholesterol to the diet.

WHAT ABOUT FAT AND SUGAR?

Beyond these basic concepts, the rest of the guidelines couldn’t be more disparate. The USDA Dietary Guidelines continue to admonish Americans to avoid saturated fat, cholesterol, sugar and salt. WPF disagrees with most of these positions, encouraging healthy fats like butter and whole milk from grass fed animals. Ironically, WPF’s position is most aligned with current scientific thinking. Both of the groups agree trans fat is a problem. Interestingly, the FDA (a co-regulator of the food supply) continues to allow trans fats GRAS status. This means that in the world of food additives it is “generally regarded as safe”.

Both groups discuss the problem of excessive sugars and refined starches, but WPF definitely has the stronger voice. The USDA guidelines still allow for 10% of Calories from refined sugar. The USDA guidelines encourage Americans to eat more fiber, but not enough is said about eating less refined starch. Again, FDA’s position does not help. The FDA allows high fructose corn syrup along with a growing list of alternative sweeteners GRAS status, despite significant research linking these substances to metabolic issues and health problems.

FOCUS ON NUTRIENTS LITTLE MORE THAN BIOCHEMICAL MANIPULATION

I respect the science behind the USDA Dietary Guidelines, but the focus on nutrients often misses the point of eating. The science is easily manipulated into reductionist sound bites. The focus on nutrients distracts attention from critical aspects of soil ecology, farming, and food production.

Consumers have been taught to be preoccupied with the nutrient label. They often miss the big picture as they are eating mostly packaged foods. I have clients who eat berries for antioxidants, eat cottage cheese for leucine, avoid meat because of saturated fat and cholesterol, and drink sodium ladened sports drinks while telling me how they avoid salt in the diet. This is not eating. It is little more than biochemical manipulation.

CELEBRATING WHOLE FOODS

There is much to celebrate with the whole foods approach of Healthy 4 Life, as outlined by the Weston Price Foundation. Likewise, an argument can be made that there is value in learning about the role of individual nutrients in foods as encouraged by the USDA Dietary Guidelines. A problem occurs when preoccupation with individual nutrients trumps the value of eating whole foods.

Given the polarized nature of these two different sets of recommendations, the enduring challenge for consumers will be to determine an approach to food that works. This is the public health nightmare. It may be that there is no one right way to eat. The question remains, what approach to food works for you?

Filed Under: Blog Tagged With: calories, cholesterol, Dietary Guidelines, eating, farming, fat, FDA, fiber, food, food label, food nutrient, fruit, health, high fructose corn syrup, Marion Nestle, public health, satruated fat, sodium, soil, starch, sugar, trans fat, USDA, vegetable, Walter Willet, weight, Weston Price Foundation

The Limitations of the 2010 USDA Dietary Guidelines

October 18, 2011 by

Last week I heard Dr. Roger Clemens speak at the California Dietetic Association meeting in Pasadena. Dr. Clemens is a member of the 2010 Dietary Guidelines scientific advisory committee.

I am grateful for the candid discussion. I would never know the limitations of the 2010 USDA Dietary Guidelines if I only read materials printed by the USDA. Dr. Clemens spoke with honesty and humility. We really don’t know much about human nutrition. We only think we do.

NUTRITION IS A YOUNG SCIENCE

Nutrition is a young science, studied for a bit over 100 years as a specific scientific entity. Vitamins were discovered in the early 19th century. We didn’t appreciate the role of fiber until the 1970′s.

We are still debating how carbohydrate, protein and fat influence metabolism and energy utilization. We want to believe calories count, but maybe not as much as the hormones and other regulators that determine what we do with those calories.

During Dr. Clemens talk, five key messages resonated with me.

1. The 2010 Dietary Guidelines are not prescriptive. The guidelines are developed as a public health policy tool. It is a recommendation for the population, but not necessarily for individuals. This means there is plenty of range for people to figure out what balance of carbohydrate, protein and fat works for them. We do not all need to be on a lower fat diet.

2. Calories count, but no one is looking at hunger and satiety. There is not enough data to tell us which diet is better. Research shows that if you restrict calories, every diet works well to help people lose weight.

The problem is that no one is asking the dieters what they think and how they feel. We really don’t know more than calories count. Knowledge is not the same as behavior. It is time we look at what behavior science can tell us.

3. Too much refined sugar and starch is a problem, but the research that was considered didn’t find any distinctions between the impact of high fructose corn syrup, sucrose in white table sugar or any other sweetener. This is a situation where the time lag is glaring.

The dietary guidelines were drawn from research that is about 5-10 years old. The guidelines are always looking backwards at what we know, not what we are finding out. The onerous time lag makes it very difficult for me as a practicing dietitian to support the static position of the guidelines–especially since the current ones will be around for another five years.

4. The 2010 Guidelines continue to tell us to eat less fat, less saturated fat and cholesterol even as more current research tells us that fat is not the problem .

This is exactly the kind of rear view mirror thinking that is inherently a part of public policy that relies on research that takes decades and longer to plan, fund, conduct, and then publish results. It takes even longer to understand. No one study is significant by itself, so we need additional research for corroboration.

One saturated fat, stearic acid, is already vindicated. Stearic acid is naturally found in ruminant animals (cattle, goats, sheep, bison), along with milk and milk products from the same animals. It is also found in cocoa and chocolate. Stearic acid is not associated with increased risk of cardiovascular disease.

Milk, cheese, and red meat have been vilified for decades–and now we know better. In his talk, Dr. Clemens remarked that if you subtract the stearic acid component of saturated fat from beef and cows milk, there would no longer be enough saturated fat to be a problem, even by the old standards.

Interestingly, 8 of the top 16 sources of stearic acid in the American diet are high carbohydrate foods like grain desserts, mixed Mexican dishes, pizza, and candy. I’ve often wondered if it is the refined sugar and starch with added fats that are more of the problem, not the fat itself.

5. Sodium intake may be high, but it is not always a problem. It seems only people already predisposed to elevated blood pressure benefit from reduced sodium intake. In addition, whether someone actually develops hypertension due to the sodium in the diet depends on many other elements. Hypertension is not a single nutrient disease.

Total calorie intake, specifically overeating, is the biggest source of excessive sodium intake. If people started to eat just the energy they needed, sodium intake will drop right along with the excess poundage.

Highly processed and pre-prepared foods contribute 77% of all sodium in our diets. These foods are a major source of all sodium intake.

Just about 10% of our sodium comes from cooking and another 7-10% from the salt shaker. We don’t have to eat food that is less tasty or well prepared to reduce sodium content.

The best way to reduce sodium in the diet is to stop overeating. It is also helpful to purchase less highly processed and prepared foods. Lastly, we can learn how to season food for full flavor, not just to taste salty. By eating more fresh foods prepared at home, sodium intake will plummet even if we use the salt shaker.

GRATEFUL FOR A FLAWED BUT USEFUL TOOL

I am grateful for the impressive efforts of all the scientists, researchers, clinicians and academics who contribute to these Dietary Goals. They provide a framework for us to think about food, nutrition and health.

It is valuable to have the Dietary Goals as a reference, but it is equally important to remember the Dietary Guidelines are limited. We are still learning. The Guidelines can only tell us what was understood before 2010.

Filed Under: Blog Tagged With: calories, cholesterol, diet, dietary goals, fat, food, hunger, nutrition, public policy, Roger Clemens, satiety, saturated fat, sodium, stearic acid, sugar

GUT HEALTH: What are we feeding our babies?

Welcome to the “Post Pasteurian” Era

Losing Weight Is Not a Math Problem

A Sweet Battle: Is high fructose corn syrup nutritionally the same as sugar?

GREEK YOGURT OFFERS 2-3 TIMES MORE PROTEIN, LESS SUGAR

The Elephant in the Room: Fast Food (Doesn’t) Make You Fat

2010 USDA Guidelines: Maybe we need to change focus

Dueling Dietary Guidelines: The Weston Price Foundation challenges the USDA

The Limitations of the 2010 USDA Dietary Guidelines

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